We are living in turbulent times. If you are paying attention at all, it’s hard not to feel anxious about the state of the world we live in and the fate of humanity. While violence, war, and natural disasters have occurred throughout human history, we seem to be experiencing them today with a new level of intensity – from the effects of climate change to the rise in terrorist activity – while our leaders and politicians seem more concerned with their own approval ratings than providing actual leadership.
We also live in a “500-channel universe,” a world of seemingly infinite possibilities for distraction. Distraction is a common coping strategy against anxious thoughts or worries, but when we are bombarded by TV and radio programming that aims to offend and shock, advertising that urges us to spend money we don’t have in a never-ending quest for happiness, and the constant stream of bad news, our nervous system gets stressed, and may become overloaded.
The pace of daily life has sped up, to a speed that may actually exceed the brain’s ability to process and respond to our experience in an effective way. When I was growing up, we were promised that technology would make our lives easier, and give us more leisure time (remember “The Jetsons”?) Instead, we have less free time, with our cell phones, laptops, and tablets keeping us connected to the office and to everyone we know 24/7, even while we’re supposed to be sleeping or on vacation. This lack of down time adds to our stress and anxiety.
Anxiety and worry are normal human emotions, emanating from the part of our brain that houses our survival instincts. (Read what Rick Hanson, PhD says about the brain’s “negativity bias.”) Anxiety can be passed down in families, both as a genetic predisposition and as learned behavior. Everyone experiences anxiety at times, though some people are more sensitive to it, while others are anxious all the time. Anxiety is one of the most common reasons that people take medication (or use alcohol, drugs, or food to “numb out”). So what are some healthy ways to relieve anxiety, and calm the anxious mind?
One way is to “unplug”: see if you can turn off your devices when you’re eating and sleeping, and leave them at home while you enjoy a walk in nature. Stop watching the news on TV before bedtime, and read a book instead. Can you go for a whole day without checking email or texting? Finding ways to reduce the amount of stimulation to your brain may lower your anxiety level.
Another way is to challenge your assumptions and thoughts about whatever is making you anxious. If you’re prone to playing the “worst case scenario” game in your head, you may be scaring yourself, and making things worse than they actually are. The gold standard of anxiety treatment is Cognitive-Behavioral Therapy (CBT), which teaches you to change how you feel by changing your thoughts and behaviors. Check out this new CBT workbook: The Road to Calm
Because we experience anxiety in the physical body, as well as in our minds, Mindfulness-Based Cognitive Therapy (MBCT), a newer variation of CBT, incorporates meditation and yoga practices. As a CBT practitioner for over 25 years, and an MBCT practitioner for the last seven, I’ve found that mindfulness and meditation practice improve the efficacy of CBT, and are also stand-alone practices that can be very helpful to manage anxiety and relieve its effects.
At its most basic level, mindfulness invites us to wake up to the present moment, and notice that we’re breathing – “I’m awake and alive, right now.” While this might not strike you as a reason to rejoice, if you stop to think about it, that we breathe automatically is truly amazing. Mindfulness is about stepping out of autopilot mode, and using the breath and body to ground us in the present. However, if you’re experiencing anxiety, this can get dicey.
A typical mindfulness meditation practice is to focus on the breath. Many people find that this promotes relaxation and calmness, but if you are prone to anxiety, focusing on your breath can actually make you more anxious. You might notice that your breathing is kind of shallow, or a bit rapid, so you try to take a deep breath or slow your breathing down, but then the harder you try the more it seems to speed up, until it feels like you can’t breathe at all! Has that ever happened to you?
And did you then conclude “meditation is not for me?” The problem here is that bringing conscious awareness to automatic processes in the mind and body, while beneficial for most people, can backfire for anxious people, who are already hyper-focused on things that other people don’t even notice, like their breathing, heart rate, and worrisome thoughts. But if you give up on mindfulness and meditation so soon, you don’t give your mind and body a chance to reap the benefits, which are signficant. Herein lies the paradox of mindfulness.
Whether it’s your breath, or your life, if you start with wanting things to be different than they are, you create more stress and anxiety for yourself. Mindfulness invites you to just observe what is, without judgment or worry, and without needing things to be different. If you can do that, then change may come, often effortlessly. You might try this brief breath meditation:
Still not sure about meditation? Perhaps some mindful movement, like Yoga, Tai Chi, or Qi Gong, can help. One of my favorite forms of mindful movement is walking meditation, where we focus our attention on the sensations involved in walking, slowly and intentionally, just being present with our experience without needing to go anywhere. Walking this way, we find there’s actually a lot to notice, so we’re not just focused on the breath, and this, plus the gentle, rhythmic movements of our body, can help to calm the anxious mind. If you’d like to try walking meditation, here are some instructions:
Just as we were beginning to feel better this summer – because once again we could dine in restaurants, attend sporting events and outdoor concerts, hug friends, visit grandchildren and grandparents, and even travel – now we’ve been knocked back down by the Delta variant surge. Here we go again. Only this time it feels much worse. Why is that?
One of the worst parts of this ongoing pandemic has been the way it’s caused disconnection from so much that’s important in life: our loved ones, both near and far away; our regular social interactions within our communities; the activities and pastimes that bring us pleasure; and our ability to make plans for the future. Disconnection from what gives life meaning leads to feelings of isolation, loneliness, anger, hopelessness and despair.
The COVID-19 virus has caused illness and death for an astonishing number of Americans, and its impact on our mental health has been nearly as dire. The data are in: rates of anxiety, depression, substance abuse and suicidal thinking increased dramatically in 2020 as compared with previous years. According to a survey by the Kaiser Family Foundation, 40% of adults reported symptoms of anxiety or depression in 2020 and early 2021, as compared with 10% in 2019. Young adults report even higher rates of anxiety and depressive symptoms, as much as 63% according to CDC data from June 2020. Rates of substance use/abuse and suicidal thoughts also increased significantly for all adults during this time, double among young adults.
The explanation for these data seems obvious. At the beginning of the pandemic, we were dealing with fear of a deadly virus, not even knowing how it was transmitted or how contagious it was. Then we experienced shock, numbness, and grief as case rates and death rates kept rising, as people we knew, our loved ones, or we ourselves came down with it. On top of that were the economic effects of so many jobs lost, as well as so much uncertainty about the future. Of course we were anxious and depressed, and is it any surprise that many of us sought solace in alcohol, marijuana, and other substances, including food?
Yet over the course of the past year and a half we’ve learned to cope, adjust, find creative ways to connect with people and participate in activities online. Zoom has become our lifeline. Still for most of us, that’s simply not enough. We craved physical connection, whether hugs or just being in each others’ presence. There’s a powerful feeling of joy that comes from sharing pleasurable activities in a group (see Adam Grant’s NYT article on collective effervescence).
As vaccines became available early this year, we started feeling hopeful. By this summer, most of us were fully vaccinated, so we began to resume some normal activities. We had a taste of what it felt like, and that’s when the enormity of our deprivation over the past year really hit home. The psychological effect of having something and then having it taken away is much worse than never having had it in the first place. This is one of the reasons why it feels so much worse now. We’re grieving our collective loss and trauma.
Another reason: we now know what we didn’t know at the beginning, how to stop this virus in its tracks. Vaccines, masking, and social distancing have all been proven to work. That’s why many people are angry now. This didn’t have to happen, if everyone had just done what they were supposed to do and got the vaccine, while continuing to mask up for awhile longer. Your “individual freedom” to not mask or get vaccinated has taken away my right to move freely and feel safe in my own community. Vaccine hesitancy has become the new drunk driving.
One more important reason for our current mood: nobody likes to go backward after making progress, or lose ground in a fight – psychologically it sucks. Exhibit A: Afghanistan. Exhibit B: Vietnam. In the year-long battle against the COVID-19 virus, more American lives were lost than in both of those 20-year occupations combined, but this spring we finally had effective weapons to fight back (the vaccines) and both the scientists as well as our government were telling us we were winning the war. Then suddenly this summer, we went backward. There’s a collective sense of failure. Is it any wonder we’re all in a bad mood this August?
What to do? If we look at the science of happiness, it’s all about connection, and isn’t that exactly what our experience this spring and early summer demonstrated? So the answer is clear: we must not allow this latest surge of COVID cases to send us back into isolation again. Instead we must forge ahead, fully vaccinated and masked, hand sanitizer at the ready, not being foolhardy but not giving in to fear or despair. This is the definition of courage.
We can remind ourselves that we are definitely not as bad off as we were a year ago, that progress is being made, and that sometimes taking a step back is necessary to regain our strength and balance before we plunge back into the fight. We can remember to breathe. And we can offer a wave, an elbow bump, and a big smize to each other with our eyes, because like it or not, we truly are all in this together!Learn More
I recently had the opportunity, due to the pandemic, to attend a virtual version of an annual conference for psychotherapists that is usually held in Washington D.C. One of the webinars I attended, by Deb Dana, LCSW, offered some simple and practical tools to use with clients, based on a not-so-simple to explain theory, the Polyvagal Theory. The first tool is a ladder; the second, a map, or a series of maps.
Polyvagal Theory was developed by Dr Stephen Porges, and even though I’ve read his book and listened to several talks he’s given, I still have trouble clearly explaining it. In a nutshell, it merges evolutionary neurobiology with attachment theory to describe the mechanisms behind a hierarchy of human responses to perceived threats. These responses include one most of us are familiar with, the “Fight or Flight mechanism,” as well as a “Freeze” response. Porges’ theory helps us understand how emotional regulation is a function of interpersonal connection, how trauma disrupts those connections, and most importantly, how people can regain emotional equilibrium after being dysregulated by a threat or trauma.
Before I get to the ladder and the map, a little background. If you studied human anatomy in school, you learned that our autonomic nervous system (ANS) has two branches, the sympathetic (SNS) and the parasympathetic (PNS). The SNS governs movement, doing, while the PNS governs resting, being. The “fight or flight” response is generated by the SNS, while the PNS leads us to “rest and digest.” In a healthy functioning ANS, the two branches work in harmony. The sympathetic branch acts like the accelerator on a car, while the parasympathetic branch acts like the brake. Simple, right?
Here’s where it gets more complicated. The term polyvagal comes from the vagus nerve, which is a large nerve that connects the brain with the major organs of the body – lungs, heart, stomach – as well as the face, eyes and ears. The vagus nerve is like “command central” for the PNS. A key discovery of Porges was that there are two pathways of parasympathetic response, one of which causes the “freeze” response, when a person becomes immobilized in the face of a threat or trauma. The other pathway has an opposite response, leading to social engagement and connection. The immobilization response is a more primitive protective mechanism that all mammals have. The social engagement response is a more evolutionarily advanced mechanism, which only some mammals (dogs, cats, horses, elephants) and all humans have.
These two pathways are called Dorsal Vagal and Ventral Vagal. In the Dorsal Vagal response, the organism moves to shut down, in an attempt to save itself (think of how a mouse might feign death to escape from a cat, who loses interest when it stops moving). A person in this state may feel numb, disconnected, lost, abandoned, invisible, hopeless, and despairing. The Ventral Vagal response, in contrast, moves the organism to connect to self and others. A person in this state may feel alive, energized, tuned in, resourceful, flexible, and hopeful. Can you recall experiencing either, or both of these states?
The ladder is a visual representation of the range of responses to a perceived threat, from immobilization (Dorsal Vagal) at the bottom, to social engagement (Ventral Vagal) at the top, with the sympathetic responses that mobilize us (Fight or Flight) in the middle. The ladder is a tool that allows you to locate where your own response lies, to identify how dysregulated you are, and to see that it’s possible to climb out of immobilization into mobilization, and from there into engagement and connection. Most likely, you will need help to do this.
Polyvagal Theory recognizes that all of these responses are adaptive survival mechanisms that often operate below the level of conscious awareness. We don’t choose to fight, flee, or freeze, so there’s no reason to get down on ourselves when we do. The good news is that once we can come to understand what’s happening, we can learn how to move out of that automatic reaction into a more regulated state.
Connectedness is actually a biological imperative. People are inherently social beings, and our nature is to interact and form relationships with others. And it is within those interpersonal relationships that we learn to regulate our emotions. Think about how a baby cries when it is hungry, tired, or has a soiled diaper, and how its mother-caregiver offers comfort through a soothing voice, facial expression, and physical touch. These are instinctive responses that bring mother and child into “co-regulation” of their physical and emotional states, an equilibrium. As adults, we still want and need to experience co-regulation with others. When we do, we feel safe, at ease, relaxed, content. We can face challenges and function effectively in the world.
Trauma and other threats to our safety and well-being disrupt this natural drive to connect, and interfere with an individual’s ability to seek and experience co-regulation. The fight or flight responses, and especially the Dorsal Vagal collapse, are coping mechanisms designed to keep us alive, but they aren’t intended to be long-term modes of functioning. And they block us from establishing the connections we need to co-regulate and regain emotional equilibrium. The dilemma is, how can we engage and connect with others when we don’t feel safe?
This is where the map comes in. In Deb Dana’s process, therapist and client co-create a map or series of maps to first name and describe where the person may be on the ladder, and then identify the steps that will move them toward connection and social engagement. For example, if they are immobilized in a Dorsal Vagal collapse, the first steps may include establishing a sense of safety by doing grounding exercises, and to offer themselves some kind words of comfort and soothing gestures. The maps include both things the person can do on their own, and things they can do that involve others, for example, text a friend, accept a hug, or go for a walk in a park where there are other people around.
If you would like to learn more about the Polyvagal Theory, there are many YouTube videos with Stephen Porges, and a TED talk by his son Seth Porges. To learn more about Deb Dana’s approach to restoring emotional equilibrium, I recommend her new book, and podcast, “Befriending Your Nervous System.” And if you would like to work directly with a therapist to learn how you can use the ladder and maps for yourself, please contact me!Learn More
Today marks the one year anniversary of the day the San Francisco Bay Area region shut down, due to the COVID-19 virus epidemic that had been declared a pandemic just days earlier. Do you remember where you were that day?
I had left my office the previous Friday intending to return that Monday, but over the weekend had followed the rapidly changing news on the virus, and by Sunday began notifying my clients of an immediate move to telehealth, to help “flatten the curve” of the virus spread. I remember saying, “I’m no longer confident that using hand sanitizer and Clorox wipes is sufficient.” Back then we thought the virus was mainly transmitted on surfaces. Many of us didn’t even wear masks then, can you believe it?
So when the announcement to shelter-in-place came from the county health officers, I was at home. When I look at my desk calendar for that week, I see lots of cancelled appointments, and I remember scrambling to set up so I could do video sessions. The ballet performance I’d been looking forward to was cancelled, so instead I watched the Mr Rogers movie with Tom Hanks. And I still have the list I made of all of the meals I could prepare with the food I had on hand, starting with some healthy, well-balanced ones, and ending with canned soup and rice.
“Three weeks,” they told us, “we’ll need to shelter-in-place for about three weeks to get this thing under control.” I figured I probably had enough food to last, and I wasn’t even worried about toilet paper. It was kind of an adventure!
My how things have changed since then. As you look back on the past year, how would you describe it? As a lost year? A year of losses? Or a year of feeling lost? Has it been a year of disengagement, disconnection, and disorientation? A year of reckoning? Maybe a year of crises and opportunities? It’s been all of that, and more. For me, the one word that captures it best is “limbo.” We’ve been living in limbo.
The non-religious definition of limbo is “an uncertain situation that you cannot control and in which there is no progress or improvement,” (the Cambridge English dictionary); and “in a forgotten or ignored place, state, or situation” (Merriam-Webster). That sounds about right.
Nobody likes being in limbo, because we don’t like uncertainty, or being forgotten or ignored, or having no control over the situation we’re in. But I always remember something I learned many years ago, from a former Mills College English professor turned human development consultant, William Bridges: limbo is where life’s real lessons are learned.
In Transitions: Making Sense of Life’s Changes, first published in 1980, Bridges explained that every life transition follows a similar trajectory: “endings are the first phase of transition. The second phase is a time of lostness and emptiness before ‘life’ resumes an intelligible pattern and direction, while the third phase is that of beginning anew.”
We can recognize limbo as that time of lostness and emptiness, though Bridges had another term for it: “the neutral zone,” first described by Arnold van Gennep, a Dutch anthropologist from the early the 20th century who studied traditional societies’ rites of passage. In these rites of passage, first the person or group was separated from the familiar social context, then they experienced a period of isolation, “a no man’s land between the old way of being and the new,” and finally, “when the intended inner changes had taken place, the person or group was. . . re-integrated into the social order on a new basis.”
Bridges explained that in modern society, when we lose a job, a relationship, or move away from home, and we feel lonely and lost, it’s all too common to dwell on what we’ve lost, while anxiously seeking out the next job, relationship or community. We focus on the ending, and the new beginning, without seeing any value to the inbetween, limbo-land. But it turns out we actually need a time of enforced isolation and nothingness to reflect on what we’ve lost, and explore who we are in its absence, in order to experience personal growth. It is a time to prepare and better ourselves for the next chapter of our lives.
If this doesn’t quite make sense to you, think about what you’ve observed when someone doesn’t spend any time in the neutral zone, for example, hopping from one relationship immediately into the next: isn’t it true that they usually end up repeating the same unhealthy or unhelpful patterns? That’s because they haven’t learned any lessons from their experience.
I’ll end my discussion of Bridges’ book with this quote from it: “The neutral zone provides access to an angle of vision on life that one can get nowhere else. And it is a succession of such views over a lifetime that produces wisdom.”
Can you apply these ideas to what you’ve experienced over this past year? Can you see that while you might never have chosen to live such a strangely isolated and restricted life, you have nevertheless found some benefits to it? Has it given you a new perspective, on life or yourself? What lessons have you learned from this year of living in limbo?
(All quotes from the 1991 paperback edition of Transitions: Making Sense of Life’s Changes, by William Bridges, Addison-Wesley Publishing Company.)
We are coming up on a year since the COVID-19 pandemic hit the nation full-force, causing the shut down of schools and businesses and forcing most of us to shelter-in-place. And it’s not over yet. As that reality sinks in, it’s easy to feel discouraged, depressed, even despairing.
It might help to reflect a little, on how this year has changed us, individually and collectively. Taking inventory not just of our losses, but also what we may have gained: perhaps a new perspective, or a greater tolerance for uncertainty, or a newfound ability to be patient, or more appreciation for simple pleasures that we used to take for granted.
For me the biggest change has been in how I work, both as a therapist and as a mindfulness teacher. Moving to a telehealth practice was an adjustment, not just to the technology, but also to how it changed my relationships with my patients. I’ve noticed losses as well as gains.
Some patients chose not to continue therapy once I switched to telehealth, so I don’t know how they’re doing, though most have continued. I am meeting more regularly with many, in part because it’s now easier for them to dial in from home, rather than battling traffic, but also because the support I offer has been more needed. The fact that most insurance companies have been covering copays during the pandemic also helps. But this means that I have fewer openings for new patients, at a time when there are more people seeking therapy.
There is definitely something that gets lost in doing therapy via Zoom – I can’t see my patients’ body language, or sense their emotional energy. On the other hand, I’ve been able to meet their pets or their kids, and they’re usually more relaxed because they’re at home. I’ve also noticed that patients are more likely to ask how I’m doing, am I staying safe, and feeling well. I have stayed safe and well, and try to convey that by smiling while making eye contact with the tiny camera on my laptop. Below my silk blouse or sweater set, I wear yoga pants and flip-flops, so I suppose I am more relaxed as well.
I also do phone sessions, with patients who can’t figure out the technology, or need to call from their cars (their only private space), or who simply prefer a voice-only connection. Some take a walk while they talk, and I may listen while walking around my home office or kitchen, quietly straightening things. Needing to keep my hands busy while listening, I dug out my old knitting needles, ordered yarn, and started knitting during some phone sessions. Lacking visual cues, I ask more questions about how the patient feels, and probably interrupt more. Sometimes I think I talk too much because I can’t tell what’s happening in the silent pauses.
I look forward to the day when we can return to the office and I can see my patients fully, hear their breathing, directly sense their agitation or calm. When we can make real eye contact, and wear pants and street shoes. But I can’t predict when that day will come. Nor can I know what percentage of patients will prefer to continue with telehealth, but I am sure some will. So I can imagine a hybrid practice, where patients choose how to connect with me, and no one has to cancel because of traffic or not having a babysitter, which may make therapy more accessible.
While my license limits me to therapy with California residents only, my mindfulness classes, also now on Zoom, have begun to include people from other parts of the country, and no longer are limited by when I can get access to a conference room or classroom.
Making the transition to teaching mindfulness online had its challenges, as my students from the first class last spring will testify, but each week I have learned something new, or figured out how to adapt a lesson to the online format. I have access to things I couldn’t offer in person before, like showing videos; my students can do the practices in the privacy and comfort of their homes, and we can all enjoy a moment of levity with the cameo of a pet or child.
In my personal life, I can also see how the year has changed me. At first, I was most aware of what the pandemic had deprived me of – attending the ballet, symphony, and jazz concerts, a long-planned trip to Paris, being able to hug friends and family – but after a while, I began to discover the benefits and opportunities that this crisis presented as well.
Where others panicked when hair salons were shuttered, I saw an opportunity: I had been coloring my hair for years, starting when I was in my 30s, and now that I’m in my 60s it seemed like a good time to let nature take its course. By the time I was able to see my hairdresser again, I was glad to have my shoulder-length locks shorn, but told her “I’m good with the gray!”
With less going out, I’ve had more opportunity to read, and I’ve focused on educating myself about the history of race issues in this country, from 400 years ago to the present. I’ve learned that it wasn’t just in the South that non-whites were prevented from attending good schools, buying homes in nice neighborhoods, and owning businesses; that the federal government has aided local governments to systematically bypass civil rights laws for decades; that voter suppression activities have increased in the past decade; that even minority law enforcement officers are influenced by unconscious racial bias; and that we have in this country a caste system, that arbitrarily places “whites” in the dominant caste and “non-whites” insubordinate castes, with the descendants of slaves treated much like India’s “untouchable” caste.
I now have a clearer understanding of the causes of our political polarization and racial discord, and a deeper understanding of the ways my white privilege has benefitted me, even though I never believed I was in any way better than people whose skin color was different than mine.
I’m also aware of my “pandemic privilege:” I have a job that can be done remotely, and a comfortable home to work from; I’ve had no loss in income, while saving money I would have spent on clothes and vacations; I don’t have school-age children whose virtual learning has to be constantly supervised, nor elderly parents locked up in facilities that don’t allow visitors. I have much sympathy for everyone who isn’t so privileged, and at the same time, I’m glad that I don’t have those stressors so that I am free to focus on helping my patients and students.
These are some of the ways this past year of dealing with the pandemic has changed me – tell me, how has it changed you?Learn More